ADHD as an adult

There is no one test that says you have ADHD or not. It’s diagnosed through a thorough assessment rather than a blood test or other investigation. Its exact cause is still unclear but it does seem to run in some families, and other factors such as being born prematurely (before the 37th week of pregnancy), smoking or abusing alcohol in pregnancy, and having a low birth weight appear to play a part.

A useful starting point is the Adult ADHD Self Screening Tool on www.adhduk.co.uk, where you answer questions that relate to ADHD and are scored according to your answers.

You may have your own suspicions of ADHD, or you may have been encouraged to get assessed by your partner, close family and friends or your employer. If people have noticed problems, it’s helpful if they can offer specifics. Write these down and take them to your GP and any further specialist assessment.

Generally ADHD is felt to be under-diagnosed. Currently 3 to 6 of every 100 school children in the UK have ADHD, and three-quarters are male. It’s possible that school-age girls are under-diagnosed, as they may be able to mask symptoms better, and numbers of men and women are equal in adult clinics.

Symptoms of ADHD improve as children transition to adulthood, and they may be less obvious, like the physical hyperactivity of climbing trees or running everywhere becomes a difficulty following meetings or conversations. But most are thought that some impairments into adulthood.

Internal conflict can arise as society’s expectations of behaviour increase, and depression, anxiety and low self-esteem can often manifest as a result.

Book an appointment initially with your doctor to discuss your concerns and symptoms. They will then consider the most likely diagnosis, and they may refer you to a specialist, which is likely to be a psychiatrist or psychologist.

At this more detailed assessment, they will ask for specific instances that could suggest ADHD, they will ask about whether this has held you back in your career or academic studies, and any social or relationship problems.

One of the criteria for a diagnosis of ADHD is that you have had obvious symptoms before the age of 12. You may need to check with parents, or siblings, or have a look at your old school reports if you can’t remember.

Other criteria are that symptoms of inattention or hyperactivity-impulsivity are evident in two or more settings, and you have 5 or more symptoms of each (6 of each are required in children up to the age of 17), and these have been present consistently in the previous 6 months. For a diagnosis, these symptoms must have interfered with social, school or work functioning.

Many of the signs of ADHD can also feature in other mental health disorders – these affect your behaviour, mood and thinking. Other possibilities are depression, anxiety, obsessive-compulsive disorder or a personality disorder. While these can certainly co-exist, especially with the challenges of living with ADHD, it requires a detailed assessment to work out if ADHD is the primary condition, and this is one of the criteria of diagnosis.

Medication and therapy are available to help with ADHD, and providing both together may give the best outcome. The aim is to relieve symptoms and make behaviours easier to manage and live with, and to bring calm which may help improve concentration and reduce impulses.

CBT (cognitive behavioural therapy), mindfulness techniques and a psychoeducational group can help adults with ADHD to improve organisation, completion of important tasks, reduce anxiety and improve confidence by reducing self-critical thoughts.

Drug therapy is mostly stimulant medication, related to amphetamines, the most common of which is methylphenidate (known best by the brand name Ritalin) although there are five separate medicines licensed in the UK to treat ADHD. These are only prescribed by a psychiatrist and common side effects include poor appetite, weight loss and – occasionally – psychosis.

Atomoxetine (known by the brand Strattera) is a non-stimulant medication that can be used if this is more suitable. None of the medicines will cure ADHD, but can greatly help with symptoms.

ADDISS (The National Attention Deficit Disorder and Information and Support Service ) is a national UK ADHD charity and has lots of information on its website and in its bookstore. Mind is a national mental health charity with practical tips on the challenges of ADHD.

ADHD can feel isolating, so you may be able to find like-minded people in public forums or local support groups. ADHD UK has been ‘created by people with ADHD for people with ADHD’, and lots of information online.

You may be diagnosed with predominantly inattentive ADHD, predominantly hyperactive-impulsive ADHD, or a combination of both and it’s worth thinking about how you’ll react if you pursue a diagnosis of ADHD in adulthood.

As GPs, we find that some patients find labels restrictive and they feel unnecessarily defined by a particular diagnosis, or they feel embarrassed or ashamed of it.

For others, it can be reassuring to be able to account for certain behaviours or working or intimate relationship problems. They like being able to learn more about it, and also implement strategies to help them cope.

ADHD is classed in the UK as a disability, and therefore protection is enforced under Employment Law, and you can expect ‘reasonable adjustments’ at work where possible. This might mean regular breaks or breaking tasks into reasonable chunks, so you can still progress in your job.